Weight-loss surgery cut blood sugar more than drugs

CHICAGO, March 26 Weight-loss surgery did a
better job of controlling type 2 diabetes in overweight and
moderately obese patients than the most advanced medical
treatment for the disease, researchers said on Monday.

The study, conducted at the Cleveland Clinic and presented
at the annual scientific sessions of the American College of
Cardiology in Chicago, showed that patients who underwent
surgery were more than three times more likely to gain control
over their diabetes after one year than the group that was
treated with drugs.

Uncontrolled diabetes is a major risk factor for heart
problems, including heart attack.

"Within days and hours of surgery -- before there's any
measurable weight loss -- we saw dramatic changes. A majority
of(surgery) patients left the hospital with normal blood sugars.
However, this was not as effective for people who had diabetes
for many years," said Dr. Philip Schauer, director of Bariatric
and Metabolic Institute at the Cleveland Clinic, who led the
clinical trial.

Shauer called the findings, which were published in the New
England Journal of Medicine, "a potential paradigm change" for
how some patients should be treated for diabetes.

In the study, dubbed STAMPEDE, researchers randomly assigned
150 patients -- three-quarters of them female -- with a body
mass index between 27 and 43 into one of three groups.

There were two surgery groups -- laparoscopic gastric
bypass, a surgery that reroutes the digestive system and allows
food to bypass part of the small intestine, and sleeve
gastrectomy, a procedure that reduces the stomach to about one-
quarter of its original size.

The two surgery groups were compared with a third group that
got the most advanced non-insulin treatment for diabetes, such
as liraglutide, marketed by Novo Nordisk under the
brand name Victoza.

The research was primarily funded by Johnson & Johnson's
Ethicon Endo-Surgery Inc, a maker of surgical
instruments used for bariatric surgery.

REACHING GOAL

The main goal of the study was to reduce blood-sugar levels
as measured by a test called HbA1c, a standard tool used to
determine blood-sugar control in patients known to have
diabetes. The America Diabetes Association recommends an HbA1c
goal of less than 7 percent.

Patients in all groups had an average HbA1c level of 9
percent. The study measured those patients who achieved levels 6
percent or lower after one year.

Researchers reported that 42 percent of patients who
underwent gastric bypass surgery achieved that goal, compared
with 37 percent of patients who got the sleeve gastrectomy. Just
12 percent of the patients in the drug group achieved that goal.

"This study shows, in this group of patients who have poorly
controlled diabetes, surgery is more effective than medication
alone," Schauer said in an interview. "More doctors who treat
diabetes are going to think about surgery for these patients.

"The implication is that insurance companies might need to
reconsider coverage. Right now, there's a brick wall at 35," he
said, referring to the BMI threshold where insurers will cover
surgery.

A BMI is a number that is calculated from a person's weight
and height and provides a reliable indicator of body fat for
most people.

About 80 percent of the 23 million Americans living with
type 2 diabetes are overweight or obese.

Not surprisingly, weight loss was five times greater among
those who underwent surgery than those who did not.

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